A New Silver Bullet? The Lurasidone Story

There has been much handwringing within corridors of academic and guild psychiatry about the “dry pipeline” for new psychoactive drugs. So it is surprising that I have of late been the target of much wooing by my local Sunovion rep. I think he leaves messages for me almost weekly and he sends me missives; glossy brochures and reprints from a major psychiatric journal. What is the subject of this attention? The drug lurasidone (Latuda).

This drug was first approved by the FDA in 2010 for the treatment of schizophrenia. At the time, I did not think there was much enthusiasm for this drug. It did not seem to have much to offer above and beyond what the earlier so-called atypical antipsychotic drugs offered and since most of them were now off patent, there seemed to be no good reason to prescribe it. Sunovion boasted about its relative lack of impact on metabolism (weight gain, elevated blood sugar and cholesterol). But we have ziprasidone. They boasted about its possible impact on cognitive function, but the data were weak. This seemed like another “me too” drug, and reviewers – both those critical of and sympathetic to psychiatry – seemed to agree.

So what is the fuss about now? The FDA has just approved lurasidone for the treatment of depression in individuals who have been diagnosed with Bipolar Disorder. This has been the trend in psychiatry – many of the newer antipsychotic drugs have indications for mood disorders. The advantages for drug companies are clear; there are vastly more people who are diagnosed with a mood disorder than with psychosis. The market is much larger.

The push is huge. I have received multiple reprints of the studies that have just come out in the American Journal of Psychiatry. There are advertisements on TV. I have already had people ask me (just as instructed in the commercial), “Is this drug right for me?” In addition, the US government is reconsidering its rules regarding the privileged position the psychoactive drugs have with Medicare D, the program that pays for drugs. When the law went into effect, all psychiatric drugs in any given class had to be offered (albeit with a significant co-pay for some). The government wants to amend the rules. A number of groups are trying to block this. Sunovion is highly active in this fight. I was quoted in a Boston Globe story saying that I did not think we would lose anything if the branded antipsychotic drugs were not included in a formulary.

To be honest, I am agnostic about what approach is best for any individual. I think my role as a physician is to educate the people who consult me, to explain what I know and do not know about the problems they are having, and what I know and do not know about available treatments. If there is a drug that will help, I will offer it. Some of the people who comment here seem a priori against the notion of using a drug to reduce suffering. I do not share that view. Humans have ingested substances – to relieve pain and suffering or just to have a good time – for thousands of years. Some people want to ingest something in order to feel better. Others want to surround themselves with caring people and caring communities. Some turn towards spiritual practices. I see my role as much as an educator or guide as anything else. My gripe with psychiatry is not on methods per se but on its hubris at overstating what it knows, its failure to report on studies honestly, its creation of a narrative that does not fit the data, and its rampant conflict of interests.

So I think I have an obligation to understand lurasidone and how it may help and not help the people who consult with me.

Last week, I wrote about cognitive behavioral therapy. I tried to look at the study as critically as I would review a drug study. To be honest, I am not sure I succeeded. In some subtle ways (using the title “Paradigm Shift”, calling the study “important”), I may have tilted in favor of what I thought was a study showing modest and preliminary support of CBT. So I am mindful of being even-handed here.

In two studies (here and here), both published in the American Journal of Psychiatry, the researchers (and all authors of these studies with two exceptions were Sunovion employees) evaluated the effect of lurasidone on individuals diagnosed with Bipolar Disorder who were depressed. In one study, the drug was compared against placebo. In the other study, lurasidone was added to lithium or valproic acid; the comparator group remained on the mood stabilizer but had placebo added instead. These were both double blind, multi-center studies. This is what allowed for the FDA approval and the presumed patent extension. I am not going to review the studies in detail. In both, the authors reported a significant reduction in symptoms in favor of lurasidone with an effect size of 0.3 to 0.5. This is similar to the effect size reported in the CBT study I reviewed recently. The studies each lasted for 6 weeks although extension studies are underway. They report that the drug appeared to be fairly safe and well tolerated. There was little weight gain or impact on metabolic parameters.

There are more detailed descriptions of the study on 1 Boring Old Man’s site and I want to give him credit for the investigative work he is doing (more and more).

What I want to focus on is the accompanying editorial written by R. H. Belmaker who reports no COI. He ponders what it means that so-called “antipsychotic” drugs appear to be effective for Bipolar Disorder. After all, for over 100 years, psychiatry’s diagnostic classification system is based on the Kraeplinian distinction between Schizophrenia and Bipolar Disorder. He wonders if by the time DSM-6 rolls out, we will need to have a “unitary psychosis” categorization. He then asks if this heralds “a new era in psychiatry and psychopharmacology”? He answers this question modestly. He points out that in the first textbook of psychopharmacology by Klein and Davis, “the usefulness of typical old-fashioned neuroleptics such as chlorpromazine in many forms of depression was emphasized . . . It could be said that we have rediscovered the wheel.”

His comment betrays humility for the field;

Clinicians have become a bit jaded during a long era of ‘me too’ compounds where new antipsychotics and new antidepressants seem to appear daily—hailed by leaders of the field and feted with dinners and weekends for clinicians willing to attend, later to lose their patents and be discarded on the scrap heap of history.

He also raises an important question, “Could there be some more practical mechanism in play here such that perhaps only sedative atypical antipsychotics are useful in depression?”

I appreciated the general modesty of this editorial, but these are the questions I would have asked if I had been asked to editorialize:

How can we put any stock in a 6 week trial when we now know that over the long term, these drugs may pose some serious risks for individuals? We know that although studied for 6 weeks, these drugs tend to be prescribed for a much longer period of time.

How can we consider a study that has no active placebo? Dr. Belmaker hints at this issue with his comment about sedation.

How can we allow ourselves to be influenced solely on the basis of drug company funded studies when we know from past experience that they can be so misleading? By this time, we need to recognize that FDA approval meets the minimum standards of information we require to fully understand drug effects. We also need to know that the initial FDA reviewer did not recommend approval of this drug for Schizophrenia. Why is it that I need to go to the blog of a retired psychiatrist (albeit of a very smart and tenacious one) to find out what other studies were registered (this is critical since the FDA only requires two studies for approval but companies can do as many studies as they want)?

We know that earlier studies were likely biased by dosing issues. Why not have as an active comparator ultra low dose of a neuroleptic such as perphenazine? It is cheap, it has little impact on weight, it is as effective as other neuroleptics. A major problem with how we prescribed neuroleptics in the 70’s ad 80’s was due to excessive dosing. We began to reckon with this in the late 80’s but the message got lost as the newer drugs were brought on to the market. Why not have as a comparator a sedating non-neuroleptic drug? Even if the drug company was not required to do that, why not specifically point out these limitations rather than just hint at them?

• On a more basic level, doesn’t the lack of specificity of these drug effects support Joanna Moncrieff’s notion of a drug centered vs. disease centered approach to evaluating psychoactive drugs? How much more tortured will DSM 6 be in an effort to explain the disparate effects of these drugs? A unitary psychosis hypothesis will not address this. After all, most people who are depressed, even when the label is bipolar depression, are not psychotic. Dr. Moncrieff points out how the disease-centered approach has, among other things, blinded us to the long-term consequences of drug use. It has blinded us to the risks of drug withdrawal. These are not the challenges of “anti-psychiatrists”, these are questions posed by psychiatrists who want to have a full understanding of the benefits as well as the risks a person takes when she chooses to ingest these drugs. I pointed out that I am agnostic on interventions. But I am also agnostic on the basic “disease” premise. For me, it remains a hypothesis, one that becomes increasingly weaker in its evidence base as we learn more about the brain. This is an area in which I join company with Dr. Insel, the Director of the NIMH. When will we begin to address this serious concern?

Dr. Belmaker, to his credit, addresses the loss of confidence in our profession. But I wish he would have addressed more directly why, over time, these other drugs were discarded.

Dr. Steingard is Chief Medical Officer of a community mental health center, chair of the board of the Foundation for Excellence in Mental Health Care, and a member of the board of Mad In America Continuing Education. She is the editor of Critical Psychiatry: Controversies and Clinical Implications, published by Springer in 2019.

72 COMMENTS

“To be honest, I am agnostic about what approach is best for any individual. I think my role as a physician is to educate the people who consult me, to explain what I know and do not know about the problems they are having, and what I know and do not know about available treatments. If there is a drug that will help, I will offer it.”

Dr. Steingard,

While I wholly welcome what you’re saying there, as it seems quite reasonable, it also seems to contradict what you’ve said in the past, of your professional practices.

Therefore, with all due respect, I ask you:

Should we presume that, perhaps, you’ve come to a turning point, in your career? I.e., you’ll no longer order nor condone any forced drugging of anyone, and you’ll not support coercive drugging (nor any other coercive ‘treatment’) in any instances?

Hi Jonah,
I am trying to figure out how to answer this as respectfully as possible in a way that both honors the seriousness and importance of this question but also takes into account my own limitations of time in engaging what I know is – at least for me – a complex topic.
So the short answer is that I am not yet at the point you suggest, i.e. to “no longer condone any forced drugging”. At this time, I do not always see safe alternatives. However, I do support calling it for what it is – the tranquilization of individuals who are in highly agitated states as opposed to the “treatment” of a defined “illness” or “correction” of altered neurochemistry.

I am not yet at the point you suggest, i.e. to “no longer condone any forced drugging”. At this time, I do not always see safe alternatives. However, I do support calling it for what it is – the tranquilization of individuals who are in highly agitated states…

And, you go on to explain, that: Forced drugging is not “the “treatment” of a defined “illness” or “correction” of altered neurochemistry.”

Yes, forced drugging is plainly a form of behavioral control; so, I agree, it’s not ‘treatment’ of any illness.

However, I disagree with your implied suggestion, that forced drugging is ‘safe’ (suggesting that it is ‘safe’ is not “calling it for what it is,” IMHO); and, in my humble opinion (based on personal experience), forced drugging and coerced drugging do not produce ‘tranquilizing’ effects, in the main.

They may produce some such effect, in some people; however, they also produce effects which are profoundly disabling — and disorienting — and humiliating (to put it mildly); and, they can, potentially, produce quitehazardous effects.

And, no doubt, as a psychiatrist, you’ve heard of neuroleptic malignant syndrome (NMS).

Yes, of course, you have heard of NMS; however, I’d not be surprised if you’ve never heard of it being caused by forced drugging — because, after all, few psychiatrists would ever be willing to admit that this happens…

Forced neuroleptic drugging can cause NMS.

Of course, that happens.

For your readers who may be unaware of what NMS is:

…The first symptoms of neuroleptic malignant syndrome are usually muscle cramps and tremors, fever, symptoms of autonomic nervous system instability such as unstable blood pressure, and alterations in mental status (agitation, delirium, or coma). Once symptoms appear, they may progress rapidly and reach peak intensity in as little as three days. These symptoms can last anywhere from eight hours to forty days. […] Unfortunately, symptoms are sometimes misinterpreted by doctors as symptoms of mental illness…

Finally, it’s simply incorrect to suggest that all people who are forcibly drugged are in “highly agitated states.”

I was not in an agitated state when I was first forcibly drugged (28 years ago).

In fact, I was calmly following directions… laying quietly on an “examination” bed, in a side room, of the ER, with the “hospital” Chaplain seated beside me, holding my hand — when, suddenly, the psych-techs showed up, with their loaded hypodermic needle…

Then, I became “highly agitated” (i.e., only once the psych-techs arrived with their needle).

I screamed “NO!” — to no avail…

The effect of that assault was quite maddening.

For, without warning, they had suddenly come, to tie me down, pull down my pants and shoot me up, so they could put me (writhing) on a gurney… in order to be transferred by ambulance, to a nearby “hospital”.

[Note: I eventually passed out, in that ambulance (I guess one might describe me in that ‘passed-out’ state, as having been “tranquilized”); but, just hours later, that very same day, only shortly after awakening, I would again be forcibly tied down and shot up…]

Why was I shot up twice, that day?

Had I become “agitated” after awakening?

No. I was not “agitated” — as I was still feeling heavily sedated from the effects of having been forcibly drugged, that first time. (I could not have become “agitated” even if I’d tried, at that point.)

No one ever explained to me why I was being forcibly drugged — not the 1st time, nor the 2nd time…

So, I speculate: I think I was forcibly drugged that 1st time only because they the psychiatrist knew I would object to being “hospitalized,” and he wanted me to be “tranquilized” while in transport…

Later that same day, when I was again forcibly drugged, I think it was just to make sure that I’d remain fully subservient, in that “hospital”.

They were ‘teaching’ me about the immense power that they had over me, in order to convince me to ‘willingly’ consume their neuroleptic pills.

From reading your blog posts and your comments, I’ve come to presume that you don’t tend to see ‘clients’ who are ‘treated’ as I was…

However, please, don’t think my experiences are unusual.

In many psychiatric “hospitals,” it is standard practice to forcibly drug “patients” simply to make them docile and ‘compliant’ — subservient…

Jonah, I did not say it was safe. What I am saying is that in some instances, it may be the least harmful of the alternatives. Of course I can not speak to your own situation and I am sorry for how you suffered. As I said, I struggle with this. I am not going to defend the actions of every psychiatrist every where and I urge all of you to fight for your rights. Perhaps some of the information on this website can be of help.
At the same time, I am not going to be coy about my own role in the system. All I am saying that in the situations in which I am involved, I do not always see an alternative.

Myself, I have experienced extreme agitation with these drugs. Some people are 50 times more sensitive to neuroleptics than others? It wasn’t the brand of tranquillizer that was important, they all do the same thing. It was about getting down to the lowest levels possible until the final stop.

Fiachra states “I have experienced extreme agitation with these drugs.”

I respect Fiachra’s story. Also, I quite appreciate that observation, as it reflects my own experiences — in more than one instance — with that class of drugs (neuroleptics).

But, I differ with Fiachra, as he adds “It wasn’t the brand of tranquillizer that was important, they all do the same thing.”

First of all, I wonder, why would anyone refer to any drug as a “brand of tranquillizer” after stating that creates agitation?

(IMO, it’s extremely important to realize how language is corrupted by psychiatry.)

Again, I will emphasize that, this class of drugs (the neuroleptics) can produce effects that are anything but tranquilizing.

And, in my experience, all neuroleptics do not do the same thing.

In three and a half years’ time, psychiatrists forced various neuroleptics upon me, and coerced me into ‘accepting’ various neuroleptics; each kind had its own effects; some had effects that were uniquely torturous.

It was not merely a matter of dosing (though, the level of dosing does, of course, make a difference).

In response to Fiachra’s comment, Dr. Steingard states:

“I think that dosing is terribly important. I think we would do much less damage without necessarily sacrificing whatever benefits people may derive, if we were much more careful about dose.”

And, about forced drugging, Dr. Steingard states,

“What I am saying is that in some instances, [forced drugging] may be the least harmful of the alternatives.

Of course, forced neuroleptic drugging is never delivered in low doses… as it’s designed to totally overwhelm.

Personally, I found forced neuroleptic drugging to be pure torment — and totally unnecessary.

Indeed, after more than a quarter of a century of considering those experiences — and considering the similar experiences of many others — I think forced neuroleptic drugging is never necessary; and, I can’t help but wonder how the psychiatrist (or any other “hospital” worker) who is inclined to condone such drugging, can ever hope to heal the victim of such drugging; should that forcibly drugged individual expect to forge a genuinely therapeutic relationship with such professionals.

(I think not.)

“And in the field of psychiatry, it is the therapeutic relationship which is the single most important thing. And if you have been a cop, you know, that is, some kind of a social controller and using force, then it becomes nearly impossible to change roles into the role — the traditional role of the physician as healer advocate for his or her patient. And so I think that that — we should stay out of the job of being police. That’s why we have
police. So they can do that job, and it’s not our job. Now, if because of some altered state of consciousness, somebody is about to do themselves grievous harm or someone else grievous harm, well then, I would stop them in whatever way I needed to. I would probably prefer to do it with the police, but if it came to it, I guess I would do it. In my career I have never committed anyone. It just is — I make it my business to form the kind of relationship that the person will — that we can establish a ongoing treatment plan that is acceptable to both of us. And that may you avoid getting into the fight around whatever. And, you know, our job is to be healers, not fighters.”

Thanks Johnah,
At doses chosen for me I experienced extreme agitation, at doses chosen by me at about 2% of this, I didn’t have a problem. It made no difference whether I took the ‘new’ or ‘old’ varieties at this level. I describe them as tranquillizers because I don’t see them as medicine. The reason I consumed low doses was because I had difficulty coming off them after being on them, and this eventually resolved itself.

Well, I suppose I qualify as “anti-psychiatry.” But I am not totally against the use of psych drugs short term, especially since most of the time “psychosocial interventions” are not available. When I was representing inmates at commitment hearings, I not infrequently postponed the hearings for a few days when I perceived that the drugs they were on would soon clear their minds enough for them to be released by the hearing officer.

But there is already plenty of evidence that non-drug approaches work a lot better without damaging people’s metabolism and neurological functioning. We can go back as far as the Quaker retreats in the 19th century, and as recently as the Soteria Houses and Diabasis House and even the (I think) L Ward at a county hospital here in Northern California. All showed large percentages of people who recovered from their “illnesses” without drugs.

And of course I could mention many other facts and studies that show how people overcome their problems and are left undamaged when they are not drugged. This is nothing new for MIA readers.

I guess I am writing this to encourage Dr. Steingard and others who have some substantial position within psychiatry to say openly what they know without unnecessary qualifications. I suppose part of this is that you don’t want to get too far ahead of your colleagues, who have a lot invested, both intellectually and financially, in believing the lies of their profession.

Since I am not their colleague but one of their victims (though not, thank God, of their drugs), I have little ability or interest in having any intellectual discussion with them. I think at this point in time, there is no excuse for ethical psychiatrists not to be aware of the destructiveness of their profession as it is now practiced. The only way they will change is if and when the force of public opinion and the legal system forces them to change.

The best way to accomplish this is for some criminal prosecutions of people like Doctor Biederman, who are responsible for the disability and deaths of thousands of people. A few prison sentences for these “opinion leaders” will work wonders to change standard psychiatric practices.

Ted, I agree that in the short term psychotropics can be useful. I appreciate that you mention that few can actually access psychosocial interventions. This results in medication being not just a tool but the only tool.

The irony is that so many agencies routinely represent recovery based care, care predicated on the domains of wellness, evidence based practices, and best practices, under the general heading of consumer choice, respect and empowerment. Unless all of the aforementioned can be measured in milligrams of medications we are left with no more then the Potemkin Village words and meds can create.

I absolutely agree, Biederman should be tried and put in jail. Not just for his non-disclosure crimes, but rather for encouraging the entire American psychiatric community to go off committing iatrogenic harm on a massive scale via malpractice (according to the DSM-IV-TR) by misdiagnosing a million plus little children with bipolar.

When in reality they were dealing with the known adverse effects of antidepressants and ADHD drugs – the DSM, itself, specifically states symptoms caused by other drugs should never be diagnosed as bipolar.

Antipsychotics absolutely do not cure adverse effects of antidepressants and ADHD drug. Slowly weaning the person off the drugs that made them manic, or suicidal, or violent, or gave them brain zaps or whatever is how to help the person heal. Some people do not react well to pharmaceutical drugs, especially when mandated for fictitious or iatrogenic diseases!

As many have come to realize, frauds like “Dr.” Nassar Ghaemi continue to emulate the great drug company shill, Mitch Daniels, who advocated always blaming the victims’ so called mental illness for any and all toxic effects of their lethal drugs. Dr. David Healy has exposed this gem in his many articles. Thus, Ghaemi and his cohorts insist that drugs like SSRI’s “uncover” the bipolar that existed all along when victims get manic, irritable and suffer other SSRI effects well described in THE PHYSICIAN’S DESK REFERENCE. The same is true for ADHD kiddie cocaine. Note, the side effects in this classic reference are attributed to the toxic drugs and not uncovered bipolar as Ghaemi would have it based on the usual bogus studies. Ghaemi cites every vicious, bogus fraud lie to help push the fad fraud bipolar on everyone on the planet since that is his so called specialty bread and butter to everyone’s huge peril. He’s thrilled that the DSM 5 has expanded the evil bipolar stigma to include abuse trauma victims misdiagnosed as borderline, PTSD victims and anyone else they can sucker into this life destroying death trap by medicalizing normal behavior. Bipolar is the new “sacred symbol” or garbage can stigma of biopsychiatry increasingly replacing schizophrenia to expand stigma/drug markets as any drug rep can tell you. I feel nothing but contempt for Ghaemi and his pals as I’ve read the garbage he posts all over the web for unsuspecting victims of this monstrous bipolar fad fraud. Ghaemi pushes toxic, deadly lithium while justifying the work of paid drug company shill Biederman who created the child ADHD and bipolar fad frauds which leads to increasing numbers of destroyed victims of course. Ghaemi says he sees nothing wrong with taking drug company money for “research” as did Biederman that led to the great studies proving the efficacy and safety of toxic neuroleptics for children before the studies were even done on Biederman’s watch. Ghaemi is also a big fan of stigmatizing young children with bipolar a la his mentor Biederman — big surprise!

It’s all too clear that those like Biederman and Ghaemi pushing the life destroying bipolar fad fraud to force lethal poison drugs on millions of people from cradle to grave have no conscience and obviously suffer from psychopathic malignant narcissism.

Fiachra,
Sometimes they do. Fluoxetine came out, famously, as Prozac and then was re-packaged under the name Serafim for distress associated with menses (and in a pink pill, no less). Buproprion came out as Welbutrin and then was repackage as Zyban for smoking cessation. This seems about to happen for duloxetine whihc came out as Cymbalta. The patent ran out in 12/13 and the company is trying to get approval for the treatment of “bereavement depression. Guanfacine, an old drug used initially to treat high blood pressure is not out as Intuiv to treat ADHD.

Hi Ted,
Thanks for the comments. I guess I do not consider myself as someone who has a “substantial position within psychiatry” but I do my best “to say openly what they know without unnecessary qualifications.”
Sandy

Excellent including the questions you posed. I fear we are far away from the time when new psychotropics are not automatically greeted with the notion that they are safer and/or more effective when they bring little or nothing to the table except added expense.

Curious. Where did the notion that a trial of but six weeks was of sufficient duration? After all, we are often told that we will have to take one or more psychotropics for a lifetime?

Thanks, Joe. I am not entirely certain of how the six week study evolved but I know that the first thing that was assessed was short term outcome. I think that in the very first studies of neuroleptics in the 60’s, they may have lasted for 6 months.
From those studies, it was determined that most of the short term effects are seen over the course of a few weeks. The recommendation for long term administration of these drug came from the “relapse studies” where people who had been started on the drugs were followed for 1-2 years. In one group the drugs were continued and in the other group, they were replaced with placebo. There were many more people who relapsed in the placebo group.
However, and this is the crux of Anatomy of an Epidemic, when you follow people for longer than 2 years, it appears that on average those who stop the drugs may do better especially with regard to functional outcome (working, having relationships, etc.).

And you have the problem of withdrawal from these toxic drugs, which is usually interpreted by the system as “relapse.” If these drugs affect the brain, as we all know that they do, why is it so difficult for many psychiatrists to accept the fact that the supposed “relapse” that they are witnessing is not relapse but withdrawal? People who withdraw and taper wisely over a long period of time usually don’t suffer what is referred to as “relapse.”

My psychiatrist was not able to give me information about how to get off the so-called antidepressant that I was on. It wasn’t because he didn’t want to help, or that he was against me getting off, he had no idea how to help someone taper. This is an intelligent and well-educated young man, recently out of med school! So, I went to my pharmacist and got the information that I needed to do what I needed to do to get off the damned things. Granted, this wasn’t a so-called antipsychotic but the principle is the same.

I think physicians need to look at wider impacts than that of a treatment on a patient. There are pubic health impacts and other impacts: early death effects friends and family, long term disability effects the economy and increases welfare payments, type two diabetes increases the burden on the health system, the expense of drugs is another burden.

If safer and cheaper alternatives are available doesn’t the physician have a duty to use those for both the patient and the public good? if they are are not available doesn’t the physician have a duty to campaign for them to be commissioned?

If you haven’t read it, I highly recommend it to you since it covers all the damage done by biopsychiatry including its bogus, life destroying stigmas, toxic/useless drugs and its constant real main focus of coercion and social control in the guise of medicine. Dr. Joanna Moncrieff covers the latter issue well in articles like Psychiatric Imperialism, De-Medicalizing Misery and other works like many others. As you also know, even Dr. Insel has declared DSM stigmas invalid so anyone with a conscience should not be using them to destroy more lives.

Though I admire Dr. Nardo for exposing much of the fraud of biopsychiatry’s drug studies and so called science, he still subscribes to the nasty paradigm that such bogus stigmas like bipolar and schizophrenia are real biological brain diseases and horrific assaults to the brain/body like neuroleptics and ECT are effective remedies for these fake diseases as exposed in the above book, Mad Science with no evidence whatever showing his own many blind spots. Perhaps the fact that he believes his daughter had/has ADHD influence him while perhaps the truth may be a need to look within one’s own stubborn belief system.

You and I discussed the desire to take antibiotics for illnesses when they not only would not help, but would also do more damage like making one immune to these drugs when really needed. As I told you, as I became sadder and wiser about medicine, I realized that the doctor who wouldn’t prescribe them was right and ethical and I admire her now. That is true of most so called medications in all areas of medicine today including the bogus, useless statins with ever expanding goals to get everyone on the planet using them.

I hear your frustration when you get upset that such fraud exists in all areas of medicine and that is certainly true now for sure making one want to avoid all areas of main stream medicine like the plague today.

The problem is much, much worse with biopsychiatry in that a fraudulent life destroying stigma is used to subject people to known toxic body/brain damaging drugs with great withdrawal problems that can render the person permanently disabled as Robert Whitaker and many others expose as well as losing all human, civil, democratic and other rights forever. And this destruction of people’s lives is based on pernicious fraud created when psychiatry decided to sell out to Big Pharma when they felt at risk when Freudian analysis was waning to hijack the entire system. Thus the fraud of mainstream medicine pales in comparison to the huge harm done by the fraud of the APA KOL’s in power who callously created this debacle for such self serving purposes as so well documented by Dr. Peter Breggin, Dr. Thomas Szasz and all too many others. Dr. Fred Baughman, Neurologist, calls biopsychiatry with its life destroying stigmas and drugs 100% fraud and the worst medical crimes ever perpetrated against humanity.

You said that you found it frustrating to try to establish causes of severe emotional distress in your earlier years in psychiatry so you felt more comfortable when the DSM paradigm allowed you to simply apply bipolar and schizophrenia “diagnoses” to such human suffering. Since you and I are both older and did not grow up with this fraudulent paradigm of stigmatizing normal human suffering, crises and emotional distress caused by abuse, loss and other reasons, I find it difficult to accept that you would have so eagerly accepted such an obvious fraudulent paradigm because of its greater ease and convenience. You also contributed to a book on the toxic effects of psychiatric drugs. Did you ever consider the real horrific effects of such stigma and toxic drugs on the victims as equal human beings with equal human rights? As you watched women especially blow up 100 pounds, did you not realize how much this added to society’s contempt, disgust and prejudice against them not to mention all the other losses described by psychiatrists Dr. Judith Herman, Dr. Frank Ochberg and Dr. Carole Warshaw? If not, I hope you are thinking about it now that you have had contact with many victims of such a vicious, corrupt paradigm of so called mental health.

You are right that people may demand these toxic, useless drugs in their desperation, but that is because they are ignorant about their real short and long term effects. That is why some drugs are illegal in this country in that their potential for damage is well known. However, hypocrisy and greed are alive and well as Dr. Loren Mosher pointed out in his resignation letter to the APA in that the only “good drugs” were those from which biopsychiatry could make a profit while those illegal or other “bad” drugs that didn’t line the pockets of biopsychiatry/Big Pharma could only serve for dual diagnoses and vilifying the victims using them.

Anyway, though I appreciate your efforts to expose some of the fraud of the biopsychiatry/Big Pharma paradigm, books like Mad Science are critical in terms of exposing that biopsychiatry is rotten to the core and the only solution is that is should be completely abolished.

As you continue to sit on the fence of the deadly biopsychiatry paradigm, I hope you will consider the above along with many other factors I haven’t included here.

Despite the fact you claim to prefer Dr. Moncrieff’s drug centered model, isn’t it true that you would have to give a person a DSM label to pay for any such drugs you may prescribe where you work or in most places deadling with health insurance or Medicare/Medicaid?

Since Dr. Moncrieff is also in our age group, I was horrified when she claimed neuroleptics were necessary for psychosis at the Vatican conference no less. This certainly burst my bubble about Moncrieff’s so called antipsychiatry stance when she has also written about the toxic effects of these useless drugs including lithium too.

Such fence sitting when knowing the truth deep inside reminds me of when I was a child and like others didn’t want to admit I no longer believed in Santa Claus because I worried I wouldn’t get as many gifts.

And bogus biopsychiatry has been the gift that keeps on giving for those profiting from it while Scrooge and bah humbug prevail for its many victims driven to destruction, poverty, ill health, destroyed marriages and careers, loss of custody of children, loss of friends and family and even homelessness and needless to say a welcome early death of about 25 years thanks to the stigma coupled with lethal drugs. That’s if the victim isn’t driven to suicide due to their very real despair and/or lethal drugs known to cause aggression and suicide that will be attributed to their bipolar or other bogus stigma, of course.

It is one thing to write a diagnosis down on a form, it is quite another thing to study a drug from the perspective of its general psychoactive effects.
This concept is not too foreign for many drugs in use.
For instance, opiates might relieve pain but they are not treating a specific illness. They have effects on everyone. those effects are exploited to help people with pain arising from a multitude of sources.
Benzodiazepines are called “anti-anxiety” drugs in some settings and “hypnotics” in other settings but if a person who does not experienced anxiety took a benzodiazepine, he would experience a sense of calm and, depending on dose, would likely drift off to sleep.
Dr. Moncrieff’s point, I believe, is that the effects of neuroleptics might be beneficial to some people in some circumstances but this is not because they are treating a specific known pathophysiology in the brain.

Hi Donna,
Good to hear from you again. I am reading Mad Science now (along with a few other books so it is slow going). It is interesting but my opinions diverge at certain points. When I have finished it and have time, I may try to write about that.
Re: “You said that you found it frustrating to try to establish causes of severe emotional distress in your earlier years in psychiatry so you felt more comfortable when the DSM paradigm allowed you to simply apply bipolar and schizophrenia “diagnoses” to such human suffering. Since you and I are both older and did not grow up with this fraudulent paradigm of stigmatizing normal human suffering, crises and emotional distress caused by abuse, loss and other reasons, I find it difficult to accept that you would have so eagerly accepted such an obvious fraudulent paradigm because of its greater ease and convenience.”
The paradigm of “schizophrenia” dates back to the early 20th century. I am old but not that old! I entered psychiatry in the late 70’s when that view was well entrenched. As I may have explained, I entered psychiatry because I was drawn to psychoanalysis. I studied that fairly intensively for a number of years until I became disenchanted with that school of thought.
Not knowing what do with myself, I ended up spending a year studying behavioral neurology. This is the field of neurology that applies neurological perspectives, specifically structure function correlates, to behavior. The field got much of its momentum in the post WW II era when neurologists were confronted with soldiers who had severe brain lesions. That perspective has always influenced my thinking. We know that lesions to the brain can cause, for instance, various types of hallucinations. It is not a stretch to think there is some abnormal brain functioning associated with any one who has a hallucination. I still think that. I just do not think that means that the “treatment” for this problem is a necessarily a drug or that the problem is static rather than transient. So that is how my early thinking developed.
All of this avoids your core question regarding forcing drugs on people. I have nothing more to add right now to what I said to Jonah above.
Regards,
Sandy

“We know that lesions to the brain can cause, for instance, various types of hallucinations. It is not a stretch to think there is some abnormal brain functioning associated with any one who has a hallucination.”

Not a stretch….?? If jumping to conclusions was an Olympic event psychiatrists would win all the medals…

A thought…is a thought…is a thought…

Some thoughts psychiatrists like….these come from “good” brains… therefore thoughts they don’t like must come from “bad” brains…

It’s daft…but the graduates of medical madrassa can’t see it…won’t see it… when someone has been so thoroughly trained to see the world in one way….it becomes almost impossible to see it any other way….everything that doesn’t fit seems counter intuitive….

It’s almost as if being indoctrinated into the brain blaming cult of psychiatry leads in the end to a sort of neurological condition…. its the only plausible explanation….

Sorry Sandra…not a personal dig…just using your words to make a point…

To state it another way, I do not find it offensive that a researcher might be curious as to why one person who is, let’s say traumatized in some way, has one type of mental experience and another person has a different type. This is just a question.

At the same time, what I also said is that the explanation does not necessarily guide treatment. This, I think, is the lesson of the Hearing Voices movement. Approaching these experiences as a human experience that occurs in the context of the person’s life can be powerfully helpful. One does not need to know anything about the brain to offer this kind of help.

I say nothing about “good” brains or “bad” brains. Just perhaps, brains that may process things differently. Which I agree is true for all of us.

I am curious, what in that, do you find the daft manifestation of my medical madrassa training?

Just because something is old and has been around a long time does not make it true as Dr. Mary Boyle like others have exposed in such works as Schizophrenia: A Scientific Delusion? And Dr. Thomas Szasz exposed that schizophrenia has long been psychiatry’s sacred symbol or justification for its existence, stigmas, torture treatments and coercion that they are replacing with the latest bipolar fad fraud as exposed on the web site Yoism with Robert Whitaker, Dr. Loren Mosher and others speaking about this fraud on videos. That’s also why blood letting is no longer used in medicine as an all around remedy thanks to some progress and we no longer worship Zeuss. Sadly, despite books like Mad Science, little progress can be made as long as vested interests rather than human health and well being dominate.

Yes, convenient parts of Kraepelin were hijacked when biopsychiatry created its biological paradigm while putting less outward emphasis on Kraepelin’s focus on psychopathy, one of the greatest threats to modern humanity per Dr. Robert Hare and many others that biopsychiatry ignores for the most part, and on eugenics in the guise of genetics which is alive and well in biopsychiatry to blame the victims for gross social problems to keep the current robber barons in power. This was just a preference chosen by those promoting biopsychiatry since it fit their bogus paradigm with no evidence whatever. There have been many competing views that focused more on obvious social factors causing human distress that have been outlawed by the current DSM that even Dr. Robert Spitzer, editor of DSM III admits with regret supposedly. Spitzer admitted that if any causes of DSM stigmas were acknowledged, this whole house of cards would fall apart as it has been recently. This is why we have rape victims destroyed with the bipolar fraud fad stigma since admitting the trauma of rape, domestic violence, school/work bullying is outlawed by DSM with its sole, soulless focus on mere outer symptoms. The fact that such admitted bogus junk science stigmas can still be inflicted on vulnerable people shows that our country, medicine and psychiatry especially have lost their moral compass and are totally corrupt with only their huge profits the goal in my opinion.

I have just tried to quote/cite your views from other posts to understand your current position.

I am very glad you are reading Mad Science since it is a current critique of all the problems/junk science of DSM biopsychiatry that has received much praise from experts in the field without conflicts of interest.

Yes, those like Phineas Gage with obvious brain injuries did behave much differently, but there was obvious and well known brain damage in these cases. If I break a leg, it will also behave differently as is true of any bodily INJURY. This is certainly not true of so called schizophrenia and bipolar for sure that have been declared invalid stigmas with no physical evidence whatever to back them up even by Dr. Insel, Head of NIMH. And that’s sure not for lack of billions and decades of effort and search for the holy grail of seeking The Missing Gene and The Gene Illusion per Dr. Jay Joseph and many others exposing the fraud of the current eugenics of biopsychiatry for those in power. And the never ending search for so called “biomarkers” goes on with the latest debacle seeming to use the effects of stress and trauma as evidence for these vile stigmas like bipolar. They seem to be trying to EQUATE bipolar and PTSD now while blaming the victims’ inferior brains/bodies, which is so evil it boggles my mind. Dr. Moncrieff does admit that by stigmatizing individuals for the nefarious effects of unjust, evil social policies and abuse, society/government is acting without conscience (or psychopathic).

Despite the problems with psychoanalysis that also blamed the victims for social and other problems, there is common sense which is not so common unfortunately.

I regret if I offended you. I hope you will post on Mad Science, but given the above, I am not sure it will make much difference if you read it since you seem very set in your views that appear to maintain the status quo with a bit of tweaking of the amount of toxic drugs prescribed. The huge damage done by biopysychiatry to its victims goes way beyond its toxic drugs such as life destroying stigma, the violation of all human/civil rights and the out and out fraud to make billions for those in power used to justify the murder of millions of people from cradle to grave for the psychopaths in power described in Political Ponerology not that I necessarily agree with the supposed causes of psychopathy since I believe the potential for human evil and greed plays the major role.

Finally, though Mad Science has gotten much praise for its comprehensiveness in focusing on the big picture of corrupt biopsychiatry, such exposes have been done before while being happily ignored by those in power, which is proof that biopsychiatry has nothing whatever to do with health or well being for sure:

Hi Donna,
Thank you for being sensitive to whether your comments offend me. I would say I am more perplexed than offended. If I follow this thread, I tried to respond to these comments from above:
“Since you and I are both older and did not grow up with this fraudulent paradigm of stigmatizing normal human suffering, crises and emotional distress caused by abuse, loss and other reasons, I find it difficult to accept that you would have so eagerly accepted such an obvious fraudulent paradigm because of its greater ease and convenience.”
I think in my many posts here, I have made it abundantly clear that I question many of the prevailing paradigms of psychiatry.
If it’s true that your conclusion about me is “you seem very set in your views that appear to maintain the status quo with a bit of tweaking of the amount of toxic drugs prescribed,” then I believe I have failed miserably as a writer since most of what I write about is challenging those paradigms.
But I am not looking for your judgement or approval, only for the dialogue and, for that, I am most grateful.

Thanks for your response, Sandy. As Robert Whitaker has stated, after becoming so excited that some progress may have been made like Dr. Insel’s admission of the invalidity of DSM labels and admitting that recent studies you and Bob have cited indicate non-drug treatments may be better in some cases (all cases in my opinion except very short term relief) and the hope of such non-drug treatments as Open Dialog only to see business as usual by the KOL’s like Lieberman and his ilk described by Dr. Nardo, I confess I get very discouraged and outraged by this predatory biopsychiatry paradigm that seems to have become more entrenched with Obamacare and recent public shootings probably caused by psychiatric stigma and drugs.

So, I guess it may come off like I am taking my grief out on you when I am very upset by biopsychiatry in general given the fact that experts exposing its fraud in books like Mad Science and Dr. Peter Breggin’s Toxic Psychiatry; Your Drug May Be Your Problem, 2nd ed., Dr. Valenstein’s Blaming the Brain and many others have been ignored for decades while millions of lives have been destroyed in the process for greed, status and power by those in power. And despite such evidence, we now see biopsychiatry preying on toddlers with neuroleptics no less per the front page of MIA. Anyone not outraged by this simply isn’t paying attention in my opinion! That’s why I think the fact we are older and see how this new menace came about that did not exist in our youth is important.

I will admit I may have been unfair in that you did say that though you used to see bipolar and schizophrenia as distinct biological entities, you aren’t sure you see it that way now or don’t see it that way now. And you disagreed with Dr. Nardo on that issue, which did please me greatly. You have agreed that DSM labels are invalid, but does that influence your practice? Is there any way you can get around it or influence those in power for change? You don’t have to answer; just something to think about. If you can substitute a less damaging label even that helps alleviate the fraud such as not stigmatizing domestic/work/school abuse, mobbing, bullying/rape victims as bipolar to seal their evil, unjust fate while the abusers prevail as usual.

I can see that given your background, it would be tempting to see such long term labels like schizophrenia or bipolar as biological or neurological. But, there is still no evidence of that and such false claims have been made based on bogus evidence for decades to the great detriment of those given these stigmas while ignoring the many social and environmental causes of such symptoms:

As I’ve said before, I would rather see you in your position to minimize the harm than a blind biopsychiatrist who sticks rigidly to the biomedial psychiatry paradigm with the arrogance typical of such pseudoscience certainty doling out huge amounts of drugs in toxic cocktails as “evidence based medicine.” At the same time, I see you as having a great deal of influence, prestige and power in your profession and I wish that you would use that influence to contribute to greatly needed change on a national level since we are singing to the choir here. I have been pleased by your articles in the media contesting some sacred cows of biopsychiatry. Again, I don’t have the right to demand this while I can wish it will happen.

I guess I would ask/plead with you to not adhere to beliefs like diseased/damaged brains for any so called psychiatric illnesses like schizophrenia and bipolar without ample evidence that keeps this corrupt paradigm going when there is no such evidence now. And needless to say the less toxic psych drugs the better while I realize some people may need some type of temporary calming effect (Valerian Root works for me) when pushed to the limit in very small doses for very short periods. As I mentioned on another post, I think Xanax can work if used judiciously in fairly small doses on a short term basis and/or for a person in great distress to take in small doses on an as needed basis like facing an abuser in the courts, at work, at home, etc. Dr. David Allen advocates this on his web site and it can’t be much more harmful than neuroleptics in my opinion.

I do like a lot of the things you say you are doing like being honest and straight forward with your “patients” and allowing them to share in the decision making with informed consent. That’s progress since I still haven’t succeeded in getting my dentist to do that yet!! LOL And like you, I tend to avoid other doctors since I now realize they’ve just done me harm and no good in the past. So, as you say, you are in good company with main stream medicine, but they don’t have the power of biopsychiatry whereby they can force me to report for their bogus statins and other harmful treatments and using a life destroying stigma to enfore it by law.

Thanks again for responding. It’s true that “a soft word turns away wrath,” so thanks for the softer words to help me think better with less negative emotion I feel whenever focusing on the KOL’s of biopsychiatry and its nasty paradigm.

I do hope you will post about Mad Science though I suppose it will probably be hard for you not to be offended by it. The truth is I think psychiatry could play an important role by validating people’s reality when dealing with abusers and oppressive environments since their tormenters tend to gas light them with crazy making lies, emotional/verbal abuse and other assaults to their sanity. Sadly, biopsychiatry chose to join the oppressors with DSM III instead of siding with the oppressed as some did in the past. Have you seen the movie, Gaslight, with Ingrid Bergman and Charles Boyer? Some of us have lived through that, so it’s nice to see decency win in the end as it does in this great movie though it’s not so common in real life. And of course, diabolical greed is the motive as in many other criminal cases.

Again, thanks for writing Sandy. And it’s true that I really don’t want to offend you though I won’t deny I want to shake or wake us up from dogmatic slumber per Immanuel Kant. As I’ve said before, you are a very good sport and you certainly have guts and tenacity to have hung in here as long as you have. So much for your male counterparts who ran away at the first sign of criticism that wasn’t personal.

They use the same deception as the Abilify Ads by stating the anti depressant warnings hoping to trick the public into thinking its an SSRI. Is there a law requiring dishonesty when advertizing pharmaceuticals or something ?

As someone who is not used to this kind of advertisement, I’m always baffled that it has some positive effect for the drug companies (patients asking for it, increased subscriptions).

In my country (as in all other countries with the exception of the US and New Zealand) direct-to-consumer prescription drug advertising is forbidden. There is also no advertising of non-prescription drugs for sleep, mood and psychological disorders.

I know someone whose psychiatrist told them that since the prozac they were taking wasn’t working as well as it once did, that they needed to increase the prozac and add abilify because the abilify would “jump start the prozac and make it work faster and better!”

When I quit laughing I told the person that this was just plain and simple bull feces put out by the drug company that sells abilify. Plus I told him that the prozac is dangerous and if it does work it works no better than a placebo. The person got angry with me but a month later had a very severe “manic” experience lasting a number of days. I’ve known this person for over five years now and they’ve never been so-called “manic.” By then my friend had been shunted off to another psychiatrist at the “community mental helath center” and this psych had enough sense to tell him that he needed to be taken off of both drugs because they were what caused the “manic” experience! Thank goodness for a few good psychiatrists out there! Abilify makes the SSRI work faster and better! Give me a freaking break!

Thanks as usual for your thoughts Sandra. I really appreciate that you take the time and effort to post here, even when it is likely to feel pretty uncomfortable. I really appreciate this part of your post even if I don’t agree with it fully…

“To be honest, I am agnostic about what approach is best for any individual. I think my role as a physician is to educate the people who consult me, to explain what I know and do not know about the problems they are having, and what I know and do not know about available treatments. If there is a drug that will help, I will offer it. Some of the people who comment here seem a priori against the notion of using a drug to reduce suffering. I do not share that view.”

I know a number of people who say that drugs have seriously helped them. Even saved their lives. They get very emotional, angry, if I, or others talk about the potential negative effects of psych drugs. I get that, in a lot of cases, people feel their suffering diminish. Why interfere with that?

I honor where people are coming from. If an antipsychotic, or an antidepressant is “working for them”, who am I to suggest they are wrong? Or should stop. However, if I am a friend or their therapist, I do keep a careful eye on whether that drug or combo of drugs are causing greater health or emotional problems. And if they are, to be careful of what doctors usually suggest, which is to change to another med, up the dose or add another med. I frankly rarely hear about doctors looking at tapering the meds, or offering comprehensive programs that involve diet, exercise, therapy, sleep hygiene and peer support.

This is where I believe psych doctors could do a world of good. Just as doctors look at holistic programs for those with diabetes, heart disease and obesity, holistic health programs could deeply serve those suffering with emotional distress as well, and serve as alternatives to just one more drug.

I’ll bring up the pubic good argument again here. Dr’s have a duty wider than to just the patient. Dr’s are encouraged and have a duty to not give out anti-bio-tics to whoever wants them because of the public harm of disease resistance that is caused by excessive use of anti-bio-tics. Dr’s use the least harmful treatments to minimize the harm cause by dangerous medicines to both the patient and the wider community.

Major tranquilizer withdrawal can be serious. It can result in suicide or violent outbursts. This is a public health risk.

Anti-depressants are associated with suicidal and violent outbursts. The physician needs to consider more than whether a drug may help the patient and whether the patient likes the drug.

I don’t think there’s necessarily a conflict between “public good” and listening to the desires of one’s patients; and I think it’s indicative of some larger themes in the debates here on MiA.

I am NOT suggesting here that I’m a supporter of psychiatry. Having been a victim of its (many) flaws and still struggling to get off psych medications (after 25 years), I do strongly believe that doctors need to have FAR more discretion with prescribing, and in general, the lack of holistic thinking, as Jonathan and Sandra seem to understand (thank you!) is pretty appalling and tragic.

Yet if someone says, as Jonathan does, they are satisfied with their medications, is it his (or our) job to discourage the individual from taking them? I know I have expressed this sort of thing in the past, and received some rather unfortunate accusations from some, but the concept of ‘Recovery,’ ‘self-determination’ needs to be just that – respecting individual choices, even when we disagree with those choices. If we think about “the public good” in a way that diminishes personal choice, are we actually helping people or denying them the autonomy of choice that is so often denied to us? To me, that makes us part of the problem. Of course, presenting alternatives is of utmost importance – but still, the choice is up to the individual.

In my opinion, a ‘professional’ must acknowledge the individual good and the public good…I worry that both “pro-psychiatry” and “anti-psychiatry” (for lack of a better term right now) can both impose ideologies that limit personal choice and freedom.

Thanks, Jonathan. I feel the same way about your posts!
However, I do think there are physicians who are interested in taking a more holistic approach to addressing people’s health. I am sorry that you are not observing more of this where you work.

Where are these physicians? I don’t see it in the other specialties of medicine and I don’t see it in psychiatry in the area of the country where I live. Granted, it’s the South and we are always at least ten years behind everyone else in the coutry.

For example, I mentioned the horrible statins known to cause muscle damage and other serious harm while being mostly useless for their stated purpose of preventing heart attacks per the evidence.

I was on these horrible drugs for a while when under much stress. When I went on a health kick, lost weight, adopted a healthy diet and exercised regularly my cholesterol levels were back to normal and my doctor didn’t dare mention the horrible statins I had dumped like the plague they are after learning the truth about them. And I really resent the fact that my doctor put me on these toxic drugs without informed consent when there is no evidence that higher cholesterol causes heart attacks or related problems. As you probably know, they have just lowered the standards again to include just about everyone as potential statin imbibers. This is why I don’t go for annual physicals any more because I know what I should be doing to stay healthy by reading expert opinions like those of Dr. Joel Furhman. I also avoid all Big Pharma drugs like the plague now that I do careful research whenever they are prescribed to me or my loved ones and mostly find very bad news. Now, they are saying mammograms are dangerous and don’t prevent cancer. I’m sure glad I ignored all the prescriptions to get those. Same with hormone replacement “therapy.” Prostate cancer and much other similar cancer screening is now seen as dangerous due to false positives resulting in so called treatments that make matters far worse when no treatment was required in the first place. This is the result of main stream medicine being paid for specific procedures, prescribing drugs, etc.

So, it seems the less done in main stream medicine today, the better and I think that holds true of biopsychiatry unless natural, truly healthy alternatives are the main focus. Some doctors are urged to give a prescription for exercise for so called depression.

I just read the court hearing provided by Jonah with Dr. Loren Mosher’s testimony and he recommended valium as a drug if temporary relief of severe emotional distress is required while he believes neuroleptics should be avoided like the plague as much as possible given his experience with his Soteria project. I hope your agency is still making progress with Open Dialog and other non-drug alternatives.

Anyway, I know you were doing some creative things to promote natural health where you work and I hope you can focus on those from time to time in your articles at MIA too.

I also realize that you are very interested in a healthy life style and diet and I think I recall you saying that you have tried to adopt some of these measures in your own practice at your CMHC.

I know that there have been many good (and bad) developments in biopsychiatry recently that deserve your attention here, but I don’t think anyone could say psychiatric stigmas and snythethic drugs lead to good health. Perhaps more focus on eliminating toxic junk food and drugs including smoking that can cause our brains to go haywire and other healthy measures can be urged on your low dose patients so they will have a better chance of going off the drugs permanently and remaining healthy. Dr. Mark Hyman, author of The Blood Sugar Solution, I recommended and you said you read has many helpful natural strategies to help eliminate “psychiatric” symptoms.

I guess we went a bit off topic from your post about the new supposed wonder drug or antipsychotic, Latuda, but like you and Dr. Nardo, it is hard for any of us to get too enthused about the latest claims for new wonder drugs for so called schizophrenia and bipolar as we are a very jaded audience about biopsychiatry/Big Pharma claims for very good reason like you and Dr. Nardo. The fact these drugs have been approved for invalid disorders is as hard to swallow as any of main stream medicine’s dangerous drugs and treatments.

I also work “in the field” and am faced daily with the challenges of how to make large and substantive changes in a system without alienating those that you need to work with to bring about the change. It’s taxing stuff but people’s lives are on the line so it’s worth it.

It seems like so many of these wrongs cycle back to the drug companies’ drive for profit. Sandy, why haven’t you just kicked the Latuda guy to the curb? If more doctors just said no to drug reps and the influence of advertising we’d have fewer of the “me too” patented drugs and the problems that come along with them.

Cataract-
I have not had any contact with drug reps in about 15 years. My first directive as Medical Director was to ban them from our offices. At that time, we also banned all forms of advertisement (pens, clocks, calendars). Prior to that from about 1196 on, I did not engage with them. I can’t control who leaves messages on my v-mail or who sends me mail. Many years ago, I tried to send back some junk that Lilly sent me (it was two mylar inflated balloons with the words Prozac and Zyprexa written on them!). I went to some expense but I was trying to make a point. Before I had the option to ban them, I would give the free coupons for food to people who sought services with us. One day I drove a young rep to tears because I insisted on putting the bagels she brought with her into our waiting room and she insisted on putting them in our receptionist’s office.
But the problems and dangers are for more insidious and serious. When studies are published that are design to allow a drug to be promoted rather than for us to understand fully what the drug does to the human body, we all get turned around in how we think about the drugs.That is what I was addressing in the later part of my blog. It is what Peter Gotzsche, David Healy, MIckey Nardo address in many books and blogs. It is a serious problems that invades all of modern medicine.

Dunning–Kruger effect: The sort of Anosognosia that psychiatrists suffer from. Unskilled and Unaware of It: How Difficulties in Recognizing One’s Own Incompetence Lead to Inflated Self-Assessments” see also the idea of “Illusory superiority”.

Theinarticulatepoet-
I fear that you and I are at an impasse. I do agree that we get blinded- all of us – to our own cognitive frameworks. The best elucidation of this for me was in Daniel Kahnemann’s book, “Thinking, fast and slow”. I guess I would say that psychiatrists (including me!) are no less or more immune to this any any other human being; it is a quality of human cognition not of psychiatric cognition. I also understand why those of you who have been harmed by psychiatric practices would be so infuriated by the inability of psychiatrists to challenge their own frameworks when their models have not been as effective as they predicted they would be.
But I think you are critical of me in ways that do not directly address my own blog but address your complaint with a large group of people. That makes it hard to respond in a meaningful way. It’s fine with me if you continue to do that but please do not be offended if I do not respond.
At the same time, it would helpful if more psychiatrists could participate in these conversations. You and others here have much to offer. General critiques that are hard to rebut, make it much less likely that my colleagues will join in on this discussion. I think that is a loss for this site.

Poet-
I would add that the challenges for psychiatry – of shifting frame- are more severe than the Dunning-Kruger effect, if I am understanding it correctly. It is the years of training and work that make it harder to challenge one’s belief set.

We don’t always agree. And I come on strong at times, but I’m *very grateful* you’re here. I must say however, IMO you are not an ordinary psychiatrist. On the contrary, you are quite *extraordinary*. Any person who constantly calls on their conscience as their guide is okay by me.

And I certainly don’t mean to imply you do not constantly look for answers in scientific literature, nutrition and other areas of research. You regularly update us on your studies; what you’ve learned; what you find; what you continue to search for.

Thanks, Duane, but I will stand by what I said. In the course of 30 years as a psychiatrist, one ends up meeting quite a few of them. The majority are no different from me. Many are kinder and more caring then me. That has been my experience.
I do think the problem is more of being brought up with a certain framework for thinking about these problems. In contrast to the Dunning-Kruger effect, I think it is an education effect. It is very hard to consider that years of education might lead one to form the wrong conclusions about how to think about these problems. That does not make us evil. It makes us human.
It seems that only through discussion will people be open to reconsidering. I would like for this to be a place where everyone was respected and welcome even when we vehemently disagree.

In my journey through the system I met four psychiatrists directly who dealt with my case. I would say that two of the four are truly good human beings who probably are much like you in your journey. But they seem to believe that the drugs are the only “treatment” for people experiencing emotional and psychological anguish and distress.

The other two are arrogant and puffed up “experts” who yell and scream at people and are truly emotionally and psychologically abusive. So, I’ve had a 50/50 experience dealing directly with psychiatrists.

Being a former teacher myself I too believe that the key to so much of this is to be found in education. Consequently, I’ve moved from direct “patient” care into the education department of the hospital where I work and am putting my effort into getting my foot in the door through the means of consciousness raising presentations. One of the profound problems of the hospital is that most of the psychiatrists feel that they don’t need to attend the presentations or meetings that all other staff are required to attend. They’ve been allowed to get away with this until just lately with the arrival of a new ceo. So, perhaps some dialog may begin in the near future.

You may just be an “ordinary person” but I believe your success here on MIA is due to the fact that you admit that you don’t have all the answers and you do have a lot of questions. This is a kind of “ordinariness” honesty and humility that many of us have never run into in our dealings with psychiatry. I can’t speak for everyone here on MIA and can only state for myself that I appreciate this openess and honesty.

Sandy, as you know, I too, very much appreciate your courageous voice, here, despite the onslaught of negative reactions that can come toward you or any psychiatrist (as well as others) on this site. To me, that makes you a leader in your field, because obviously, you have the willingness to step into the mine field in order to find truth. Finding truth is not the actual intention of all (for some, it is about sabotaging truth, for self-interest or self-protection), but I believe that for you, it IS about finding the truth of the matter. That’s what I intuit, from our interactions.

I can relate to your position. I am introducing a lot of new information and perspective into healing, personal evolution, and paradigm shifting and it is a helluva task. I get so much resistance thrown at me because it seems impossible to suggest something that challenges a person’s (or community’s) long held belief without it being reacted to as if it were personal. All neutrality and hope for balanced discussion disappears quickly, as it falls on wounded or programmed ears. I find this to be the most challenging part of these discussions.

I know that personal feeling will come up, that seems natural and reasonable to me. However, this is where I introduce ownership and self-responsibility in my groups. Our emotions can inform us with subtle and interesting information, if we owned that our feelings belonged to US, rather than to the people that trigger us. If we are very empathic and feeling the feelings of others, then that should be acknowledged somehow, with neutrality and compassion. I witness that you do that beautifully. I find you to be very authentic and humble in your communication.

To me, that’s an internal paradigm shift. To have fruitful discussions, we do need to allow our emotions to surface, otherwise words ring hollow, at least to me they do . Plus, in these particular discussions around ‘mental illness’ and it’s many related complex tangents, I know we’re all fully aware of the rage that has built for a lot of reasons. And I do believe it is reasonable, no doubt about that.

But I do feel that a sense of our higher self (as in, a self-responsible and self-controlling adult) should be present at all times. When we smear, discard, dismiss, or discredit others when a perspective is presented, instead of being reasonable when we get angry, and a bit curious, communication has broken down, and things remain stuck–unless, of course, we can pull ourselves out of that mindset. All else is a waste of time and a drain on one’s energy. That’s how I see it, anyway.

Perhaps a bit off the point of your post, but after reading through the comments, I felt compelled to express this. I think you’re a wonderful example of being, both, authentic and respectful in your communication on this website, in a sea of anger, and I appreciate that very much. Thanks.

I also want to reach out to someone who e-mailed me this week. You shared your story. I am not sure I can be of much help but I did not want your message to go unasnwered. I have responed several times but the message bounces back. I wanted you to know that I did not ignore you.

Why you are here is one thing….why your colleagues are not is another. Most of the psychiatry chat here is about the science, the blind mans buff and receptor tetris combination game. That can go on anywhere…. and it does.

The community bit goes largely undressed……but thats the whole point….because if psychiatry wasn’t just a handy way of rooting problems that are the result of problems in society inside individuals…..then society would have to do something about that….politicians would have to do something about that…. something would have to change. But no. Psychiatry serves to prop up the whole crumby shooting match…..as an institution its deeply deeply repressive…..

So by all means carry on…. carry on talking about brains and how its possible to interfere with them to oh so interesting an effect….. all this chatter does is obscure where the real problems lie….. like I say, I can’t see your colleagues wanting to discuss that either….

Psychiatry isn’t just scientifically worthless….its socially harmful into the bargain….

I think that some of my psychiatric colleagues – Philip Thomas comes to mind – do address the societal role in causing all sorts of human distress.
However, I join Robert Whitaker in thinking that taking a critical look at the “mainstream” message of psychiatry, which was the point of this particular blog, is also important to effect change.

As for Philip Thomas – I’m not sure if Heidegger or Frank Zappa is the bigger influence on his writing….fluent as it is….I fear that “Hermeneutical Phenomenology” has limited sound bite potential…. but I appreciate his efforts….and yours…

I dunno, lurasidone is just another “atypical” neuroleptic drug. It works the same way as other “atypical” neuroleptics, it blocks D2 and potentially gives the same adverse effects that Whitaker, etc, have reported upon. It doesn’t have some of those sedating histamine H1 effects (same as Benadryl). The sedation effects of Seroquel, etc, may very well help with the studies on depression, in the sense the patients with Seroquel get actual sleep, because of H1. I read this new drug may be sedating, or not, through some mechanism through some new serotonin receptor. In any case, the drug very generally works in a similar adverse or beneficial ways as other neuroleptics, of course depending on dose. Really cruel to give it as an antidepressant in my point of view.

I mean, when I was actually in the “system”, I was given some SSRI first (I forgot its name), later Abilify. When in a meeting I pointed to them then I read that the metabolism of SSRI interacts with that of Abilify, the psychologist looked at the psychiatrist and after a while, the psychologist said “let’s stop the SSRI, Abilify also helps with depression”. !! Blocking your D2 sometimes does not help with depression, maybe it oftentimes causes it to a horrible degree, likewise as it causes social phobia, etc.

Though, some people like to experiment with these different receptors these drugs affect on, such as the people at http://www.crazymeds.us. There are many people who know so much about these different receptors and also often have experience about it. For instance, a short googling showed plenty of reports about akathisia related to lurasidone. It may be that drugs with more metabolic effects have less akathisia, because those exact effects help with akathisia. Or not. I don’t know, I’m done with self experiment on this field!

Hermes-
I think you are generally correct about lurasidone being pretty similar to other neuroleptics already on the market. However, I also think that the terms “antidepressant” and “antipsychotic” are largely devoid of meaning. They are marketing terms. This is a concept I came to after reading Robert Whitaker as well as Joanna Moncrieff. These are plain and simple psychoactive substances. They may have some effects that some people may find beneficial but it is clear that they do not fall along the lines created for them 40 years ago. If you read Dr. Belmaker’s editorial this is abundantly clear as he tries to parse this out.
I have probalby already said this, but Dr. Moncrieff’s conceptualization of a maintaining a drug centered as opposed to a disease centered approach to thinking about these drugs has been enormously helpful to me.

Yes, I agree. Those people talk about these different psychiatric drugs and their effects on different receptors the same way some recreational drug enthusiastics talk about what receptors their drugs affect. It’s pretty much the way I see it. They are psychoactive substances that act on those receptors.

However, I do think that there’s certain complexity with this thing. For instance, I think all things we think and experience are also related to our body. For instance, when someone is very stressed up and acting in a fight-or-flight-manner, etc, it’s entirely possible that, for instance, his dopamine receptors are acting in a high state, etc, and neuroleptics will dampen that thing quite crudely. Should that be seen as disease? As in, there may be so many different things in life that will cause different kinds of disturbances in body, such as dopamine activity or NDMA receptor blockage in the end, which may be related to certain types of behaviour or subjective experiences sometimes seen as mental illness. I guess it’s possible that there are many different pathways (social, trauma, nutrition, stress, lack of sleep, etc) that can lead to kind of disturbances in body, and those may involve more active dopamine receptors, NMDA, cytokines, etc. At times it may be “biological” in that sense. Often they have kind of claimed that, for instance, schizophrenia is one single cellular level disease. I haven’t seen much proof of that.

I mean, a pure brain disease in my opinion would be something like a virus that goes to your brain and forcibly blocks maybe NMDA receptors so that you’ll fall into hallucinations despite what’s going on in your life or body otherwise. I haven’t seen much proof that, for instance, “schizophrenia” is a brain disease in this sense. There may be some cases of people diagnosed as schizophrenia or bipolar who have a brain disease in this sense.

The use of psychotropic drugs to treat mental disorders is a field of medicine that is very much in its infancy.I think that many of the harsh critics of these medicines would do well to remember that.It does not mean that there is not tremendous potential in this field and to dismiss all of the advancements in psychiatry with such broad strokes is a reactionary retreat in to ignorance.Pschiatry is a hit and miss medical practice still in a highly experimental stage of its development and as long as it is viewed as such bitter dissapointment shall not arise.

I would like to add two other frustrations with the field of psychiatry that you have alluded to but left off your list — the need to individualize the approach to each patient and the total lack of awareness of the vast knowledge available in the research literature.

The first issue is one of how doctors talk about drug efficacy. A drug study can say that 60% of patients significantly improved but 5% were significantly harmed and doctors conclude this is a good drug – and don’t even try to understand you as a patient and whether you have the factors that will predict which group you are most likely to fall into. (Even though if you dig even deeper into the literature, these factors frequently have been identified .) Conversely they do the opposite when the numbers point the other direction.

Yet ultimately drug efficacy come down to how you as an individual respond and not what some sample produces in means and p-values. Sometimes you are the mean, and sometimes you are the outlier.

As an MH patient, I fell into this trap for many years – only going after the ‘best bets’ and continually coming up in the bottom 5% group. Once I came to understand that “I am not the mean” I was more open to trying a broader range of interventions and I did find something that works – even though the use of it for my DSM code number was considered ‘off label’ and ‘contradicting the evidence.’ Why? Because the specific underlying biochemical problem I had that was exacerbating my symptoms was not at all related to the baseline levels of serotonin or dopamine (but was apparently messing with them on occasion.)

Second, there is a lot that is known about these conditions but there are hundreds of interaction variables that can combine to produce symptom patterns and drug response patterns. This type of complexity requires supercomputing (or super-intuitiveness) to decipher and is not something that can be understood in a 15 minute DSM style question and answer session. Yet that seems to be all that psychiatry’s intelligentsia want to talk about — perpetuating the status quo. And all the countermovement wants to do is play semantics games with the medical lexicon and debate brain-mind duality .

Of the 42 reports identified by the authors, 33 were sponsored by a pharmaceutical company. In 90.0% of the studies, the reported overall outcome was in favor of the sponsor’s drug. This pattern resulted in contradictory conclusions across studies when the findings of studies of the same drugs but with different sponsors were compared.